=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548998628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOLOGY CENTER OF HAWAII LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2022
-----------------------------------------------------
Last Update Date | 08/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1440 KAPIOLANI BLVD STE 1200
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-722-1270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1440 KAPIOLANI BLVD STE 1200
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-722-1270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYD
-----------------------------------------------------
Name | APOSTOLIS AMAXOPOULOS
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 808-722-1270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------